侵犯气管的甲状腺癌切除后锁骨头带蒂软骨修补术12例报告

目的探讨甲状腺癌侵犯气管的外科处理及预后。方法分析2001年1月至2005年12月对12例甲状腺癌侵犯气管2～4个软骨环,周径<50%的患者,行气管窗式切除后采用自体胸锁关节的锁骨头带骨膜肌瓣软骨修补气管缺损区的疗效。结果本组乳头状癌9例,滤泡状癌1例,髓样癌1例,B细胞淋巴瘤1例,均行甲状腺全切除术加患侧颈淋巴结清扫术。分化性甲状腺癌术后辅助Ⅰ治疗;B细胞淋巴瘤术后辅助化疗。术后半年纤维气管镜检查可见气管修补处已骨化,气管内黏膜拉网脱落细胞检查未找到癌细胞。全组随访6个月至4年,1例滤泡状癌于术后3年气管内局部肿瘤复发行气管镜下微波治疗和再次Ⅰ治疗后病情得到控制,仍然存活,其他病例无复发转移及死亡,生活质量较好。结论甲状腺癌侵犯气管采用前侧壁窗式切除结合自体带蒂软骨修补气管壁缺损是一种有效的治疗方法。

Thyroid carcinoma invading the trachea: treatment by partial tracheal resection and repair using the pedicled cartilage of the clavicle head in 12 cases

Objective To evaluate tumor resection and trachea repair using pedicled cartilage of clavicular head for the treatment of differentiated thyroid carcinoma invading the trachea.Methods Clinical data of 12 thyroid cancer cases treated by 'window'(local)resection of the tumor invaded portion on the front wall of the trachea and one-stage repair with pedicled cartilage of the clavicular head were analyzed retrospectively.Result From Jan 2001 to Dec 2005,12 thyroid cancer cases with trachea invasion were surgically treated in our hospital.The tracheal invasion ranged from 2 to 4 rings with less than a half of the circle.Total thyroidectomy and tumor-sided neck lymph node dissection,and postoperative radioisotope ~(131)I treatment was applied to all except for one case of B-cell lymphoma who underwent postoperative chemotherapy instead.Tracheoscopy follow-up at the sixth month showed complete epithelialization with no granuloma formation on the surface of the flap and apparent new-formed edmetaplastic bone in all cases.Tracheal balloon cytological examination did not find cancer cells.All patients were followed-up from 6 months to 4 years.One case of thyroid papillary carcinoma suffered from local recurrence after 3 years and was treated with microwave and renewed ~(131)I therapy and was still alive. Conclusions Differentiated thyroid carcinoma infiltrating the ventral wall of trachea treated by 'window' resection and one stage repair with sternocleidomastoid myoperiosteal flap is useful,safe and effective.